This brief segment summarizes an important randomized trial in which people with knee osteoarthritis fared just as well with nonsurgical treatments such as pain killers and physical therapy as they did when they received these treatments plus arthroscopic surgery. The study confirms findings from an earlier sham-controlled trial showing that people with osteoarthritis of the knee were no better after arthroscopic surgery than after sham surgery.
The segment covers some of this essential information, but not all. Missing are mention of the costs of treatment, which are substantial–and arguably the driving force behind the study; the harms of treatment, which appear to be few and rarely serious; and the fact that people randomized to receive surgery also received nonsurgical treatments.
The newscast also overstates the trial’s conclusions. In an attempt to explain precisely who the findings apply to, it cites an orthopaedic surgeon who wrote the editorial that accompanied the new study. He says that many people who have arthritis “have other problems such as a torn meniscus or a loose piece of cartilage in the knee who may be helped by arthroscopic surgery.” What is the evidence to support this statement? Is it based on findings from a high-quality randomized trial—or the same type of observational evidence that for so long led people to believe arthroscopy was beneficial for arthritis? (Answer: To our knowledge, the latter.) The study’s authors say their findings to not support this view. They write, “Although some may argue that treatment is beneficial for patients with mechanical symptoms of catching or locking or those with early [osteoarthritis]”—i.e., patients with symptoms attributed to meniscal tears or stray bits of “cartilage”—“prespecified subgroup analyses also failed to show efficacy in this population of patients.” The investigators go on to remind readers that their trial intentionally excluded people with large meniscal tears (known as “bucket handle” tears), “in whom arthroscopic surgery is considered an effective intervention.” Note that the researchers do not say that arthroscopy is “proven” to be effective even in these people.
The researchers’ well-designed and carefully executed trial attempts to answer a very important but specific question. This segment both under-informs and misinforms viewers about its meaning.
The story says that arthroscopy to treat knee osteoarthritis is “not worth the expense or risk,” but it fails to mention what the costs are either to the individual or the community. Costs are substantial, and arguably the driving force behind the study. To ignore them is a significant oversight.
The newscast accurately states that arthroscopy is usually not helpful for people with knee osteoarthritis. It does not mention the duration of the trial (2 years) or the outcome measured (a validated arthritis assessment score).
Moreover, one of the physicians interviewed in the story appears to overstate the findings. He suggests that arthroscopy may be beneficial for people whose only problem is a tear of the meniscus. The study’s authors specifically address this view, and suggest that it may not be true. They write, “Although some may argue that treatment is beneficial for patients with mechanical symptoms of catching or locking or those with early [osteoarthritis]”—i.e., patients with symptoms attributed to meniscal tears—“prespecified subgroup analyses also failed to show efficacy in this population of patients.” They go on to point out that their trial intentionally excluded people with large meniscal tears (known as bucket handle tears), “in whom arthroscopic surgery is considered an effective intervention.” Note that they do not say that arthroscopy is “proven” to be effective even in these people.
Viewers hear the word “risk” once during the newscast—in the closing line of the story. But the story says nothing about the seriousness or frequency of the risks. Fortunately, risks appear to be few and serious problems rare.
The newscast explains the key study design facts—that this is a randomized, controlled trial. However, in saying that the researchers randomized people “to either receive the surgery or just physical therapy and pain relievers,” it fails to adequately describe the treatments. Those who had surgery also received the nonsurgical treatments, an important design feature.
The newscast does not exaggerate the importance of knee osteoarthritis, a widespread and often disabling condition.
The newscast cites two sources—a coauthor of the new trial and an independent source with no apparent conflict of interest.
The story describes some of the nonsurgical strategies (physical therapy and pain relievers) used to treat knee osteoarthritis, although the amount of detail is quite limited.
It’s clear from the newscast that knee arthroscopy, performed “almost a million times a year,” is widely available.
The newscast makes it clear that this treatment has been around a while, and studied before.
There is no obvious use of text from the press release.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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